Menace of diabetes highlighted

A seminar was held at a local hotel last Sunday for updating the knowledge of general practitioners and family physicians about the latest advancements and research made in the treatment of diabetes. It was attended by a good number of physicians from all over the country.

Speakers read out well-prepared papers on various causes of the menace of diabetes, its symptoms and effects on human health. However, there were only 167 persons present in the hall a majority of whom were sale representatives, executives and promoters of pharmaceutical companies and attendants of consultants.

One is wonder struck by the poor attendance in a city which is planning to launch another medical college and which has thousands of students and hundreds of teachers. In the Agriculture University alone, out of 458 teachers, there are 255 Ph.Ds whereas in the National Institute of Biotechnology and Genetic Engineering, the Nuclear Institute of Agriculture and Biology, the Ayub Agriculture Research Institute and the Forest Research Institute, there is also a sizable strength of teachers and students all of whom would have benefited from such an illuminating gathering.

Its organizers admit that they had arranged 250 chairs in the hall and that 516 persons had been registered. Many of them preferred to stay out and wait for lucky draw prizes arranged for attracting doctors and students. Throughout the seminar, over two dozen doctors were seen smoking outside the hall.

A sociologist commenting on this situation said lottery schemes for attracting professional doctors to the seminar, which was in fact a part of their education, were an eloquent commentary on the deterioration of society.

It was observed that a number of senior consultants i.e. professors, associate professors and assistant professors serving in the Punjab Medical College, including those who retired in the recent years, were conspicuous by their absence.

Most of the papers presented in the seminar were by Dr. Rana Mohsin who, in fact, seemed to be the motive force of the event. No worth mentioning office-bearer of the Pakistan Medical Association was seen active at the seminar.

Seminars and workshops play an important role in the dissemination of knowledge among the professionals and the ordinary citizens. The apathy of the medical professionals towards such a function is deplorable.

Speaking on the occasion, specialists warned that if steps were not taken to arrest the increasing rate of diabetes, the entire nation would have to pay a very high price in terms of impaired health. They said there were about seven million diabetics in the country, which was an alarmingly high number. Lack of awareness, disregard of preventive cure and poor dietary habits mainly contributed towards this high number. Awareness about the detrimental effects of the disease would help in its prevention and cure through timely treatment, remedial measures and scrupulous observance of doctor’s advice.

Underscoring the need for an advanced course with increasing frequency, speakers said the bulk of public care rested in the hands of overworked and under-informed general practitioners, adding that “education was not simply a part of treatment: it was the treatment”.

Enumerating the problems faced by general practitioners in the treatment of diabetes, they said it was a pity that there was no paramedical staff specially trained to look after the diabetics. They called upon the general practitioners to educate their patients about the early signs and symptoms of the disease so as to ensure timely advice to them at early stages.

They said with a little effort the general practitioners could enable the diabetics to monitor and check their sugar level, which would in turn help in checking the growth of diabetes-related complications in areas of ophthalmology, dermatology, surgery and cardio-vascular diseases.

They said: “In 25 per cent patients, vaginitis is a common complication of poorly-controlled diabetics. Vular itching or white thin to creamy discharge should alert the clinicians to the possible presence of diabetes. Necrobiosis lipoidica diabeticorum is prevalent in 0.3 per cent of diabetics. It is three times more common in women than men, characteristically found on the interior and lateral surfaces of the lower legs, face, arms and trunk. There may be one or several lesions either unilateral or bilateral. Lesions being as small, dusky red elevated nodules sharply circumscribed and slowly enlarge becoming a plaque irregular in outline, and is eventually depressed as the dermis becomes more atrophic. The colour becomes more brownish yellow except of the border, which remains red. The lesion may be anaesthetic due to destruction of cutaneous nerves.”

They said like all other complications of diabetes Mellitis, dealing with the occular complications was also teamwork. Neither ophthalmologists nor family physicians alone could deal with it. It needed proper initial assessment on the one hand and high-tech facilities on the other. The patient had more tendencies to develop blepharitis. Tear film abnormality led to dry eyes. Simple lubricant ointment served the purpose. Improvement of local hygiene had no substitute, they said.

According to speakers, monitoring erections that occur during sleep (nocturnal penile tumescence) can help rule out that certain causes of impotence are likely to be physical rather than psychological. Tests of nocturnal erections are not completely reliable. However, scientists have not standardized such tests and have not determined when they should be applied for best results. This means treating the primary cause is considered first. Psychotherapy and behaviour modifications are considered next.

A comprehensive and multidisciplinary approach is recommended for care of diabetic feet. Our patients are not fortunate enough to get all these specialized services due to a number of reasons, thus it will be cost-effective and patient friendly if foot complications of diabetes are prevented by general/family physician. The cornerstone of prevention policy is to recall a forgotten lesson of keen, clever and quick clinical examination of the foot which demands a few simple questions about patient’s habits about their feet and a few simple observations.

“The patients having developed a non-healing ulcer or infected ulcers, localized gangrene, frank gangrene and grade 1-5 diabetic foot along with systemic problems of diabetes like hypertension, ischaemic heart disease, nephropathy and retinopathy shall be referred to specialized centres. These are the patients who desperately require active involvement of surgical discipline. The colleagues in surgery are now constrained to adopt a range of procedures from limb preservation to amputations (life saving). The aim is to preserve as much of foot as possible for optimum ambulation”, they maintained.

They said a patient who had never experienced hypoglycemia practically had never been in good control. Frequent hypoglycemic symptoms requiring multiple unscheduled food intakes may be the underlying reasons for failure to lose weight. Moreover hypoglycemia was more dangerous in patients suffering from cardiovascular disease, in elderly and patients on concomitant B-blockers drugs and in those with hypoglycemic unawareness and autonomic neuropathy. Whenever an upward change in hypoglycemic drugs was prescribed, patients must be warned and reminded of possible hypoglycemic symptoms, they said.

Similarly, family members and colleagues along with the patients himself must be aware of the symptoms and the appropriate action in response well before drowsiness hampers the oral intake. Once oral intake is not possible attendants must be aware of buccal and rectral application of glucose containing pastes, and need to reach a medical facility. At the same time, doctors must be prepared to give intravenous glucose even if classical hypoglycemic symptoms are not present in a confused or unconscious patient. Giving few ampoules of 25 per cent glucose will cause no harm even to a hyperglycemic patient.

The seminar was attended by general practitioners of Faisalabad, Jhang, Toba Tek Sing and Sargodha, and presided over by Prof Dr. Altaf Husain Rathore and Prof Dr. Irshadul Haq.

Research papers were read by Dr. Muhammad Asim, Dr. Raja Mazhar Iqbal, Dr. Amir Chaudhry, Dr. Hashim Imran, Dr. Mohsin Rana, Dr. Akhtar Rasheed, Dr. Yousaf Hasan, Dr. Sohail Farooq and a number of other renowned professionals.

GST — a revenue at the cost of patient’s life

“MY mother must have it,” the young man cried. “She is suffering from a severe attack of asthma and we have run out of medicines.”

“I wish I could help,” said the pharmacist. “But the drug for asthma you are looking for is out of stock; there is a shortage”, he replied ruefully.

“Goddamn it”, the young man mumbled in desperation as he turned to leave the pharmacy.

The pharmacist shocked looked up, but the man was already out of the store, perhaps to check with the next drug store.

Feeling for someone’s suffering is perhaps easy enough to do, though it might do little to mitigate the distress of someone desperately looking for an asthma drug that has vanished from the market without a trace.

In many drug stores of the twin cities of Rawalpindi- Islamabad, similar situation is being encountered by those seeking essential medicines for treatment of heart ailments, acute epilepsy, high blood pressure and tranquillizers. They are either not available or are made available sporadically, but of course, way above the company price.

The reason, as revealed, by the pharmacists and wholesalers is the ensuing tug-of-war between the health authorities and drug distributors over imposition of the general sales tax (GST) and thus creating shortage of medicines in the market. A number of wholesalers said they had stopped buying new stocks of drugs with stamps of sales tax on them from distributors of pharmaceutical industry. The old stock has been consumed leading to shortage of many drugs, a wholesaler said.

Interviews revealed that several life saving drugs were in short supply in the market forcing patients to dole out extra bucks to buy them in black market, and at exorbitant costs.

Pharmaceutical industry leaders disclosed that the problem of essential drugs vanishing from the market is not uncommon, mainly because of a lopsided policy framework, that has over the years turned the country into a smugglers’ paradise for medicines, which are smuggled to the neighbouring countries at the expense of the patients, industry, and the exchequer. Yet the government has failed to check smuggling of drugs across the borders where they have a find a better market.

Research shows that last year, pharmaceutical and biotech companies in the United States alone spent over $30.3 billion on medicinal research. The year saw the US Food and Drug Administration (FDA) approve 32 new treatments, 24 drugs and 8 biologics including innovative treatments for AIDS, arthritis, cancer, glaucoma, heart disease, infectious diseases, schizophrenia, Alzheimer’s, migraines and other diseases.

The new medicines will help treat or prevent 32 diseases. According to an estimate, these will help American society save $250 billion a year in other healthcare costs as well as lost productivity and wages. Proportionate benefits will accrue to the rest of the world, including Third World countries, which cannot contribute directly to this process due to paucity of resources.

However, pharmaceutical industry leaders believe defective regulation and undue restrictions throttle investment in medical research and development in countries like Pakistan which is tantamount to arresting the pace of search for new cures. The logical result is the unmitigated suffering of the sick for want of cures, a doctor in an MNC said.

He said the situation is hardly conducive for developing a local research and development capability in Pakistan. Decades of wrong policies have distorted the market environment in unthinkable ways, he said.

The outcome of the myopic policy followed by the government has led to closure of nearly 80 pharmaceutical companies out of some 400 operating in the country over the last few years.

Explaining how the shortage of drugs is created in the market, industry sources said the price controls and regulations with imposition of taxes over the years lead to smuggling of drugs to neighbouring countries including India and burden on the industry.

Sources in the industry said by the end of 1999, pharmaceutical manufacturers were grappling with a cost increase of over 100 per cent from 1994.

The four factors leading to this stellar rise were an inflation of 97 per cent, rupee devaluation against the US dollar to the tune of 96 per cent, a 10 per cent custom’s duty imposed beginning July 1996, plus imposition in 1999 of 15 per cent sales tax on packaging materials, sources said.

Moreover, the pharmaceutical manufacturers are struggling to keep their nose above the water in the face of a broad range of market access barriers and deficiencies in intellectual property protection, sources said.

Contrary to the reasons given by the industry leaders for drug shortage, officials believe majority of multinational pharmaceutical companies create artificial demand for drugs on the pretext of shortage of raw materials and taxes to mint extra profits.

With negotiations between the health ministry and the pharmaceutical industry on for resolving the row over the newly imposed GST, the black marketeers are minting money by capitalising on patient’s miseries. Insiders said Dalintin tablets used in acute cases of epilepsy, sometimes fetch a price tag of Rs500 per 100 tablets as compared to the company price of around Rs50 per 100 tablets.

Lescol, a capsule for treating high blood pressure, which sells for around Rs540 is not available in the market at present at any price. The widely used Buscopan, a tablet manufactured locally by some MNCs, is in short supply and selling at almost three times the original price in the black market.

Tryptanol, Angesid, Thyroxin, Inderal, Zextrol, Ventloin, and many other drugs are in short supply, a retailer said.

Saima: Out of sight, out of mind

HONOUR killing is murder. There is no doubt about it. However, in a country like Pakistan, where, women, specially those from rural areas, are already caught in an inescapable maelstrom of false and suffocating values and norms, the practice stands out as the last nail in their coffin.

To make matters worse, the role of judiciary, parliament, legislature, clergy, and the society in doing justice to the victims, by holding the culprits accountable for inexcusable crime, leaves a lot to be desired. The victims are not only conveniently forgotten, but the killers are also let off the hook and allowed to tread the earth with ‘pride’ for successfully ‘neutralizing’ the ‘threat’ to the family’s honour.

Today is April 6. Exactly on this date, three years ago, at around 6pm, Saima Sarwar, a 29-year-old mother of two, was gunned down in cold blood at the office of reputed lawyers, Asma Jehangir and Hina Jilani, by a professional killer, engaged by her mother and uncle.

She was one of those thousands of women who fell prey to the anti-women laws and traditions such as Qisas, Diyat.

Her crime was that she wanted to exercise her right to Khula (divorce), guaranteed to women by Islam, but not acceptable to her parents because, for them, it was a blot on the family honour, ego, prestige and reputation.

It is to be remembered that Saima’s parents came from the upper echelon of society. The mother was a doctor, and father, a prominent entrepreneur.

This murder enraged women, human rights organizations, and civil society members. It was widely reported in the print media. A few protests, marches, seminars, and demonstrations were held, followed by a dead silence. The state remained indifferent to the protests. The Senate argued in defense of honour killing, rejecting a resolution condemning Saima’s murder. On the other hand, some so-called clerics, at the behest of victim’s father, issued fatwas against Ms Asma and Ms Hina, declaring them kafir, for spreading obscenity among women.

Saima’s uncle, who also accompanied the killer and stayed outside the office to see to it that the ‘job’ was done without any interruptions, was indicted by the sessions court, but soon released under the qisas and diyat laws. He husband and father in the capacity of her wali(guardian) pardoned the uncle.

Ms Hina protested over the judgment, contending that the perpetrators could not be the judge, and filed a revision- petition in the High Court, that was rejected on technical grounds. Now, she has filed a revision-petition in the Supreme Court, which has been accepted for hearing. — MOHAMMAD SHEHZAD

Boring talk shows

PTV has been trying for quite some time to become a bit more credible and news oriented in terms of its coverage of current affairs and world events. Readers might remember that a couple of years ago there was talk of starting a round-the-clock news channel. But then the government probably realized that given the nature of control over the dissemination of information it would look ridiculous to keep broadcasting the same tepid news all the time. And, telling the people what a good job the government and all its ministries are doing — something that Khabarnama has become perhaps too much of an expert at — would drive them even further away from PTV.

What is PTV doing these days? Perhaps, the one feather in its cap — credit should be given where it’s due — is the use of Syed Talat Husain, actually from the print media, to host the daily News Night current affairs talk show. Mr Husain has the guts and the presence of mind to not be awed by ministers or other senior government officials and asks them reasonably tough questions. One recent interview which later became quite controversial was that of the current railways minister Lt-Gen Javed Ashraf Qazi (retired) who went on a tirade against journalists. However, in this show with the former head of the ISI, Mr Husain did manage to get his point across to the minister saying that it was often the governments who took the initiative in contacting certain journalists for possible patronage or manipulation, meaning that the press was hardly the only party to blame over the issue.

Apart from News Night, we have various talk shows and current affairs programmes these days. Unfortunately, these are extremely boring and do not add anything to an educated viewer’s knowledge or comprehension of world events. In most cases, even the choice of moderator is not a good one because most of them have been around for too long and despite that have yet to make any kind of impression on audiences. In some cases, the moderators themselves seem to lack knowledge of the issue under discussion, do not have good language skills or have an irritatingly high or low pitched, voice. However, the worst quality that most of these moderators have is that they seem either unwilling or unable to challenge the ‘experts’ on the panel. Maybe the retired generals, ambassadors, bureaucrats or minister overawe them.

Unfortunately, even Indus Vision — which one would have thought to be better than state-run PTV — has succumbed to this boring format, by inviting boring ‘senior’ columnists or other ‘eminent’ guest to their show. In many cases, the guests invited seem to have no relevance to the issue at hand. For example, Indus is often guilty of calling local Karachi politicians to discuss the Pakistan-India tension or the Middle East situation. Well, they might as well call a cabbie or the panwallah from down the street. Another problem — and a serious one — is that most of the guests have a propensity to ramble on and on. They can never confine themselves to the specifics of the question or issue at hand.

For example, a straightforward question on the Gujarat riots would not get a straightforward answer. Instead, viewers would — that is, if they haven’t the sense to switch to another channel — be forced to listen to the history of partition, and of everything that followed between India and Pakistan, and of India’s betrayal of secularism, and of the riots that followed Indira Gandhi’s murder, and the Babri Masjid demolition, and so on. Of course, all of this would be couched in the ‘expert’s idiosyncratic (being used here as a euphemism) manner and rather relaxed (read slow) style of speaking.

Take another very topical issue these days: the referendum that Gen Musharraf plans to hold to apparently consolidate his grip on the presidency. Well, PTV has been doing something on this but has anyone seen any opinion contrary to the officially subscribed view coming under discussion? Have any politicians who have spoken out openly against the referendum been called to explain their position? Or even any non-politicians?

Unfortunately, so much has been written and said about these aspects that it probably makes no difference to the news or current affairs producers of these channels to make any changes. However, wouldn’t it make sense that with the ban on Indian channels still on, that PTV, Indus Vision and the other local channels, try and improve their shows so that people actually want to see them out of habit and not because of a lack of choice. Presumably, the safety of a monopoly or the misunderstood notion that grey hair or writing on the op-ed pages of a newspaper make you an expert makes all this possible. And as usual, it’s the poor viewers who suffer the most since they have to suffer all this drivel. — OMAR R. QURAISHI

Discovering the orthodox in Shah Husain

MELA Chiraghan or Mela Shah Husain used to be a festive occasion when spring was in full bloom in Lahore and lamps were lit at the shrine of Madho Lal Husain who died in AH 1008 and lies buried in Baghanpura. But the occasion has lost most of its colour ever since the gates of the Shalamar Gardens, where the gathering converged, have been closed upon the mela and later, even drum beating banned in the streets around the shrine. Even otherwise, the area has been ruthlessly encroached upon.

Madho Lal Husain, better known as Shah Husain, was a disciple of Sheikh Bahlol Daryai Chinoti and studied mysticism on his advice. He also spent 12 years in penance at the shrine of Hazrat Data Ganj Bakhsh. His life continued changing and he began to believe that the mind could be illuminated even by taking to festivity, dancing and drinking. Like all sufis, he was a nonconformist. He did not believe in ritual but in direct communion with the Almighty. He even shaved off his beard and moustache. He then took to poetry but has left only 165 kafis of a highly mystic nature. Despite that, he is regarded as the biggest Punjabi sufi poet after Baba Farid. He was often seen in the streets of Lahore dancing and singing his kafis.

“I dance,” he said, “because the doubt has vanished. I am full of faults and without any quality. Show me compassion, Oh Allah. The worldly people are proud of their riches. To the recluse, renunciation is a cover. I am neither a recluse, nor a worldly man. So everyone laughs at me. I am Husain, the Faqir of Allah.”

To mark the 409th urs of the sufi poet, the Punjabi Adabi Board arranged a seminar in the Quaid-i-Azam Library. It was supposed to be presided over by the information secretary, Kamran Lashari, with the governor of the province as the chief guest, but, naturally, VIPs do not have time for minor functions and did not show up. As such, Prof Fateh Muhammad Malik, chairman of the National Language Authority, was asked to take the chair. To conduct the proceedings was Parvin Malik. Speakers on the occasion were Dr Shaista Nuzhat, Mushtaq Kanwal and Col Nadir Ali. I was surprised to hear some of the speakers trying to link a free thinking sufi like Shah Husain with some of the orthodox schools of thought.

The erudite Muzaffar Ghaffar was also there that afternoon. He has conducted a research on Punjabi sufi poetry and written a series of books on the subject. He presented his translations of some of Shah Husain’s kafis. I reproduce a few lines from Thori reh gaee ratri...

Little remains of sweet night, the beloved not enjoyed

Only she’s in wedlock, in the beloved’s arms who’s buoyed First a drinking closet, then no lamp, no light

Infernal agents yank the arms, no ally, nothing to unite

Little remains of sweet night...

The history of Urdu prose begins in the AH 708 when an elderly and pious person, Jahangir Samdani, wrote a book on mysticism. Then it was Khwaja Bandanawaz Gaisudaraz (AH 720-825) who wrote a number of articles on religious subjects. But the Urdu novel started much later than in Europe where the first one in Spanish appeared in AD 1612.

In Urdu, epic stories like Dastan-i-Amir Hamza, Gul Bakauli and Fasana-i-Azad were written earlier but the first Urdu novel is considered to be Miratul Uroos written by Deputy Nazir Ahmad in 1869.

Now here I digress from the commonly known origin of the Urdu novel. There are critics who see the origin of the Urdu novel in Ghalib’s letters which were published in two volumes, UD-i-Hindi and Urdu-i-Mualla. Yet others say that the first formal novelist of the language was Pandit Ratan Nath Sarshar. But the fact remains that Mirza Hadi Ruswa’s novel, Umrao Jan Ada, which appeared in 1899 is the first modern novel as it has funds of sociological information which is the main thing in realistic fiction. On the other hand, Deputy Nazir Ahmad’s novels are heavily moralistic. It is obvious that he wrote with the intention of reforming society and instructing young women to be good housewives.

As everyone knows, Dr Moeenur Rahman is a leading Ghalibologist of the country and an ardent collector of rare books. I am lucky that he happens to be a regular reader of my columns. The one about the Urdu novel has prompted him to write and add to my knowledge. He tells me about an Urdu novel in his personal library which, he says, was published much before Miratul Uroos. However, it is not an original work. It was a British official serving in India, Henry Carre Tucker, who produced an abridged version of Grace Kennedy’s novel, Dunallan. He then asked his ‘munshi,’ Babu Shiv Parshad to translate it into Urdu. The Sidandra Orphan Press, Agra, published it in 1855 under the title Dunallan aur Qarina. It ran into several editions. It was finally printed by the renowned Naval Kishore Press in 1910. However, its title was converted into Gulab aur Chambeli and the characters given India names.—ASHFAQUE NAQVI